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Friday, February 15, 2013

Sharing Savings with Patients

The other day, my wife and I had to make some choices about a piece of DME equipment that she needed.  I spent a good bit of time researching various options, and we wound up choosing a piece of equipment that was half the price of other options presented.  It wasn't just the cost that helped us to make that decision, it was also recommendations based on quality and reliability, and we didn't choose the cheapest unit.  But still, we spent about half of what we could have.  We spent all of this time because I want to optimize my use of my HSA.  This has a real financial benefit, but it isn't an obvious one for many.

In thinking about the Medicare Shared Savings program, a thought occurred to me that healthcare providers are getting the opportunity to share savings.  What would happen if in addition to sharing savings with providers, insurers (including Medicare) shared savings with patients.

How would this work?  Payers would need to establish and share with patients the costs they expect to have with respect to care for a specific condition or injury.  They'd also have to share with patients the costs of various care options.  At the end of each year, for each condition or injury experienced by the patient, where the patient's treatment cost the payer less than the expected amount, the patient would be reimbursed a portion of the saved amount.  This is a much more obvious financial incentive that would very likely have a much larger impact on patient behavior.

It would take a heck of a lot more transparency and information than patients have today about the costs of care.  Most insurance calculators that I've seen don't cut it.  What I've seen is that they compute the cost based on the treatment that they expect providers to give, rather than what we as patients get.  My favorite story is the $44 dollar ice bag that we were charged for for one of my wife's PT visits.  After we got the first bill, she told them she'd do that at home during the next visit.  And the insurance calculator never figured that into our (or their) costs.

Imagine what could happen if patients had such an obvious financial incentive to take a more active role in their care.


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